2409 S Towner St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not ex6eed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. frJLU. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. ,a- -t)&r. , understand I may obtain more information regarding my obligations as an "employea'from the lnternal Revenue Service, the United States Small Business Administratlon, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321 -CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. t )k'tO I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financiallyjePpoDsib]f) foj+roposed construgtign activity at the followingaddress: dYL'/) \ I r; uL,trl Z.t )I 'l -r.-t /1J!:-'t',.I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ,)f-/ !\lZ.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the pe rmit. /Vote-' A copy of the property owner's driver's license, form notarization or other verification le to the a c ,s tre to be resented when the it is ,ssued to the ow s,nature Signature of Property Owner u5 R t L/era Date 1-zS *zo1 Print name of Owner L I tA I ( AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the executjon of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my prolect. Scope of Construction Proje Project Location or Address: ct (or Description of Work)q5 )W q ?274 R *r<^',., (Q.,\n Lonr,,-- l\', n z- Address of Authorized Agent:.lo 5 I declare under penalty of information and certify its Property Owner's Signatu Print Name of Owner: perjury that I am thF property owner for_tle address listed above and I personall ,54 ,.' T il;,,un" Date: c< y lllled out the above/- z9 -201 7 accuracy re a itll(i uc{q. Note: A copy of the owne license, form notarization, or other yerification acceptable lo the agency is required to be presented when the permit is issued to verify the property owner's signature. Plrn[ WP5:]i:lo!ni.jA.t,r,y As.mhrye s/N.:.c l. Pr.i.ii Fo_in a.a l4-:416 SANTA ANA CITY COUNCIL Mgle A. Pu do Michele Madr.ez Vicenle Samienlo Jose Solorio P. Davd Be.avidesMayor Mayor Pro T6m, Ward 2 Ward 1 Ward 3 Wa.d 4 moulidorasanla-ana.oro him8dinez@santa an..oro vsamienlo@ssnla-ana oro isolorio@santa-ana.oro dbenavides@santa-ana oro ivilleoas@sanla-ana.oro slrnaero@sanla-an. ora Name of Authorized Agent: Phone Numberof Authorized Agent: 1 \L\' 6,(3J- 11 ?Lj